| NPI | 1891780912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA05689400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA056894) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2016-11-30 |